2015-2016
Verification of Non-taxable Income
Your 2015–2016 Free Application for Federal Student Aid (FAFSA) was selected by the federal processor for review in a process called verification. The
law says that before awarding federal student aid, we must ask you to confirm some of the information you reported on your FAFSA. To verify the
information you provided, please complete the questions below, include signatures, and mail or fax the form to the Financial Assistance Office within 2
weeks of your receipt of this letter. Failure to respond could result in our inability to disburse Federal Pell Grants, SEOG and Perkins Loans. If
corrections need to be made to your FAFSA, the Financial Assistance Office will submit the changes on your behalf.
If you file for financial aid as a Dependent Student (reporting parent information on the FAFSA),
answer each question below as it applies to you and your parents.
If you file for financial aid as an Independent Student (reporting only your income and a spouse
income if married), answer each question below as it applies to you (and your spouse).
If any section does not apply, enter “N/A”. Return the form to the address on the bottom of
this form. If you had any earnings, please also send copies of your W-2(s).
______________________________________________________________
Student’s Last Name
Student’s First Name
Student’s M.I.
__________________________
Student’s Social Security Number
______________________________________________________________
Student’s Street Address (include apt. no.)
__________________________
Student’s Date of Birth
______________________________________________________________
City
State
Zip Code
(
)_______________________
Student’s phone number
A. Payments to tax-deferred pension and retirement savings
List any payments (direct or withheld from earnings) to tax-deferred pension and retirement savings plans (e.g., 401(k) or 403(b)
plans), including, but not limited to, amounts reported on W-2 forms in Boxes 12a through 12d with codes D, E, F, G, H, and S.
Don’t include amounts reported in code DD.
Name of Person Who Made the Payment
Total Amount Paid in 2014
B. Child support received
List the actual amount of any child support received in 2014 for the children in your household. Do not include foster care
payments, adoption payments, or any amount that was court-ordered but not actually paid.
Name of Adult Who Received
the Support
Name of Child For Whom Support
Was Received
Amount of Child Support
Received in 2014
C. Housing, food, and other living allowances paid to members of the military, clergy, and others
Include cash payments and/or the cash value of benefits received. Do not include the value of on-base military housing or the
value of a basic military allowance for housing.
Name of Recipient
Type of Benefit Received
Amount of Benefit Received in
2014
D. Veterans non-education benefits
List the total amount of veterans non-education benefits received in 2014. Include Disability, Death Pension, Dependency and
Indemnity Compensation (DIC), and/or VA Educational Work-Study allowances. Do not include federal veterans educational
benefits such as: Post-9/11 GI Bill, Montgomery GI Bill, Dependents Education Assistance Program, VEAP Benefits.
Name of Recipient
Type of Veterans
Non-education Benefit
Amount of Benefit Received in
2014
E. Other untaxed income
Other untaxed income not reported in items 45a through 45h, such as workers’ compensation, disability, etc. Also include the
untaxed portions of health savings accounts from IRS Form 1040, line 25. Don’t include extended foster care benefits, student aid,
earned income credit, additional child tax credit, welfare payments, untaxed Social Security benefits, Supplemental Security
Income, Workforce Investment Act educational benefits, on-base military housing or a military housing allowance, combat pay,
benefits from flexible spending arrangements (e.g. cafeteria plans), foreign income exclusion or credit for federal tax on special
fuels.
Name of Recipient
Type of Other
Untaxed Income
Amount of Other Untaxed
Income Received in 2014
F. Money received or paid on the student’s behalf
List any money received or paid on the student’s behalf (e.g., payment of student’s bills) and not reported elsewhere on this form.
Enter the total amount of cash support the student received in 2014. Include support from a parent whose information was not
reported on the student’s 2015–2016 FAFSA, but do not include support from a parent whose information was reported. For
example, if someone is paying rent, utility bills, etc., for the student or gives cash, gift cards, etc., include the amount of that
person's contributions unless the person is the student’s parent whose information is reported on the student’s 2015–2016
FAFSA. Amounts paid on the student’s behalf also include any distributions to the student from a 529 plan owned by someone
other than the student or the student’s parents, such as grandparents, aunts, and uncles of the student.
Purpose: e.g., Cash, Rent,
Books
Amount Received in 2014
Source
By signing below, we certify that all of the information reported on this verification worksheet is complete and correct. If you file for
financial assistance as a DEPENDENT student, at least one parent must sign.
_____________________________________________ ___________________________________________________
Student Signature
Date
Parent/Stepparent Signature
Date
(required if you file for aid as a DEPENDENT student)
Mail, fax, or bring this form to:
Meredith College
Office of Financial Assistance
3800 Hillsborough St.
Raleigh, NC 27607
Fax: (919) 760-2373
Phone: (919) 760-8565